2022-11-15T07:08:01-06:00 2021-12-31 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2021-01-01 236276101 MENNO-HAVEN INC MENN 7172621000 2011 SCOTLAND AVENUE CHAMBERSBURG PA 17201 ALISA MILLER INTERIM CFO 7172621000 2022-11-14 1 ALISA MILLER XXX-XX-XXXX KERRI N BOGDA CPA P00760402 7177404863 2022-11-14 X 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z HUGH DAVIS 2011 SCOTLAND AVENUE CHAMBERSBURG PA 17201 64163918 0 X WWW.MENNOHAVEN.ORG X 1964 PA OUR MISSION IS TO BE AN INNOVATIVE ORGANIZATION THAT NURTURES THE HUMAN SPIRIT. 12 11 780 189 106528 0 4273486 9972470 45113093 46499116 4474776 2968572 883356 1163866 54744711 60604024 3700 1210 0 0 28538348 28064868 0 0 187712 29358540 31187387 57900588 59253465 -3155877 1350559 219827975 224712119 179019970 179829408 40808005 44882711 X OUR MISSION IS TO BE AN INNOVATIVE ORGANIZATION THAT NURTURES THE HUMAN SPIRIT, IS PASSIONATE ABOUT SERVICE, AND DEMONSTRATES GOD'S LOVE, ONE PERSON AT A TIME. 0 0 22311042 1210 20540834 MENNO HAVEN INC. OPERATES TWO LIFE PLAN COMMUNITIES IN CHAMBERSBURG, PA. THE BROOKVIEW CAMPUS HOUSES THE MENNO HAVEN REHABILITATION CENTER, A 44-BED, EXCLUSIVELY, SHORT-TERM REHABILITATION CENTER. IT IS A MEDICARE LICENSED SKILLED NURSING FACILITY THAT PROVIDES STATE-OF-THE-ART REHABILITATION. IN ADDITION, THE BROOKVIEW COMMUNITY ALSO HAS THE NEW 56-BED BROOKVIEW HEALTH CARE CENTER. THE CHAMBERS POINTE CAMPUS OPERATES THE 60-BED CHAMBERS POINTE HEALTH CARE CENTER. EACH OF THESE FACILITIES OFFER ROOM AND BOARD, NURSING CARE, MEDICAL AND REHABILITATION SERVICES, SOCIAL SERVICES, AND ACTIVITY PROGRAMS. 12841011 0 11853897 MENNO HAVEN INC. OPERATES TWO LIFE PLAN COMMUNITIES IN CHAMBERSBURG, PA. EACH CAMPUS OPERATES LICENSED PERSONAL CARE AND RESIDENTIAL LIVING FACILITIES. THE BROOKVIEW CAMPUS OPERATES THE VILLAGE SQUARE PERSONAL CARE, WHICH IS LICENSED FOR 84 UNITS AND PROVIDES ROOM AND BOARD, LIMITED NURSING CARE, MEDICAL AND REHABILITATION SERVICES ALONG WITH SOCIAL, WELLNESS, AND ACTIVITY PROGRAMS. THE CHAMBERS POINTE CAMPUS OPERATES TWO PERSONAL CARE FACILITIES. THE MANOR PERSONAL CARE WHICH IS LICENSED FOR 94 UNITS AND PROVIDES ROOM AND BOARD, LIMITED NURSING CARE, MEDICAL AND REHABILITATION SERVICES ALONG WITH SOCIAL, WELLNESS, AND ACTIVITY PROGRAMS. ADDITIONALLY, MENNO HAVEN'S TWO 12-BED MEMORY CARE HOMES OPERATE AT THE PERSONAL CARE LEVEL OF CARE IN THE HOUSEHOLD MODEL. 14057002 0 12976413 MENNO HAVEN INC. OPERATES TWO LIFE PLAN COMMUNITIES IN CHAMBERSBURG, PA. EACH CAMPUS OPERATES A VARIETY OF INDEPENDENT LIVING UNITS FOR INDIVIDUALS AND COUPLES WHO WISH TO MAINTAIN MORE INDEPENDENCE BUT DESIRE THE ACCESS TO THE FOLLOWING CONTINUING CARE SERVICES: EMERGENCY NURSE CALL, WELLNESS CHECKS, WELLNESS PROGRAMS, CULINARY SERVICES, GROUNDS, MAINTENANCE, AND TRANSPORTATION SERVICES AS WELL AS ACCESS TO THE OTHER LEVELS OF SERVICES PROVIDED AT MENNO HAVEN. THE BROOKVIEW CAMPUS HAS 81 INDEPENDENT LIVING ("IL") VILLA HOMES, 192 IL COTTAGES, AND 74 IL APARTMENTS. THE CHAMBERS POINTE CAMPUS HAS 112 IL COTTAGES AND 47 IL APARTMENTS. 1221902 0 1127972 MENNO HAVEN, INC. OPERATES HOME AND COMMUNITY BASED SERVICES, WHEREBY THE ORGANIZATION PROVIDES HOME CARE SERVICES TO INDEPENDENT LIVING RESIDENTS AND THOSE SENIORS WHO ARE LOCAL TO THE COMMUNITY WHERE THEY CAN ACCESS THE SERVICES. 1221902 0 1127972 50430957 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 104 0 780 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA MD X ALISA MILLER INTERIM CFO 7172621002 2011 SCOTLAND AVENUE CHAMBERSBURG PA 17201 WAYNE YEAGER CHAIR 1.50 X X 0 0 0 ARNOLD BARBOUR VICE-CHAIR 1.00 X X 0 0 0 DARRELL BAER SECRETARY 0.70 X X 0 0 0 DALE HORST BOARD MEMBER 0.40 X 0 0 0 PAMELA GAUDIOSE ASST. SECRETARY/TREASURER 0.60 X X 0 0 0 MATTHEW NOLT BOARD MEMBER 0.50 X 0 0 0 CHARLENE GINGRICH BOARD MEMBER 0.40 X 0 0 0 LYNN MACBRIDE BOARD MEMBER 0.20 X 0 0 0 LYNN C ROTZ TREASURER 0.90 X X 0 0 0 PAULA WARNER BOARD MEMBER 0.50 X 0 0 0 PATRICK O'DONNELL BOARD MEMBER 0.80 X 0 0 0 SUZANNE TRINH BOARD MEMBER 0.80 X 0 0 0 HUGH DAVIS CEO 40.00 X 356116 0 51243 DAVID GENTRY CFO (UNTIL JUNE 2022) 40.00 X 215745 0 23740 ROGER BEINS COO 40.00 X 182792 0 18776 CHARLES NELSON CHIEF DEVELOPMENT OFFICER 40.00 X 181450 0 18298 TIFFANY RIFE COMMUNITY LIFE OFFICER 40.00 X 152252 0 16416 LARRY LUGARO DIRECTOR FACILITIES DEVELOPMENT 40.00 X 159596 0 25777 ROSALYN BURKE ADMINISTRATOR 40.00 X 133300 0 25564 HEATHER PIERRE EXEC. DIRECTOR FINANCE 40.00 X 128029 0 20913 LAURA MINTEER EXEC. DIRECTOR TEAM SVCS. 40.00 X 175099 0 5771 CHRISTINE SHANK DIRECTOR NURSING SERVICES 40.00 X 106790 0 3089 1791169 0 209587 14 0 1 0 SELECT REHABILITATION LLC PO BOX 71985 CHICAGO IL 60694 THERAPY 2507837 ECI SERVICES 124 WEST CHURCH ST DILLSBURG PA 17019 CONSTRUCTION 1817608 QUALITOX LABORATORIES 1556 ISLAND AVENUE MCKEES ROCKS PA 15136 LAB SERVICES 1010650 WAYNESBORO CONSTRUCTION CO PO BOX 229 WAYNESBORO PA 17268 CONSTRUCTION 785324 DAVID H MARTIN EXCAVATING 4961 CUMBERLAND HWY CHAMBERSBURG PA 17202 CONSTRUCTION 514619 14 7032038 2940432 1513725 9972470 NURSING & PERSONAL CARE 623000 46499116 46499116 46499116 1385474 1385474 163664 105546 58118 58118 58118 4954108 83338 3024540 429808 1929568 -346470 1583098 1583098 MEALS 900099 739929 86128 653801 HAIR CARE 900099 114342 114342 MAINTENANCE SERVICES 900099 57742 57742 193735 20400 173335 1105748 60604024 46499116 106528 4025910 1210 1210 1216828 1216828 21485800 18253751 3148347 83702 398256 287307 108567 2382 3324226 2704706 610984 8536 1639758 1305061 330442 4255 45319 45319 83500 83500 1211 1211 259165 259165 1473130 1100645 337016 35469 269602 269602 3197225 2942776 217025 37424 906421 20096 886325 4588805 4169537 403324 15944 178051 169322 8729 64879 24655 40224 5875374 5875374 7945721 7945721 417376 205340 212036 MEDICAL EXPENSES 3989412 3989412 COVID COMPLIANCE EXP 904040 904040 EMPLOYEE EXPENSES 193460 21992 171468 MEDICAID NF ASSESSMENT 176179 176179 618517 333833 284684 59253465 50430957 8634796 187712 2700 2750 2448931 9711710 1033028 771482 2266043 2308718 441814 374822 1288922 1153580 225972986 86413740 141527125 139559246 67424777 67266310 3394635 3563501 219827975 224712119 5285130 5520826 37740202 40085324 126209815 124936113 167746 506862 201500 201500 9415577 8578783 179019970 179829408 X 31019776 35004900 9788229 9877811 40808005 44882711 219827975 224712119 X 1350559 2555281 168866 X 0 1 X 1 0 X 1595802 2734691 4390939 4273486 9972470 22967388 45862179 47106803 47084441 45113093 46499116 231665632 47457981 49841494 51475380 49386579 56471586 254633020 28500 24862 15474 28782 18318 115936 0 28500 24862 15474 28782 18318 115936 254517084 992247 1202119 1229670 1219247 1549138 6192421 992247 1202119 1229670 1219247 1549138 6192421 687756 768475 815090 722183 999220 3992724 49137984 51812088 53520140 51328009 59019944 264818165 0.96110 0.96500 0.02340 0.02250 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: HAIR CARE - 2017 AMOUNT: $ 227,581. 2018 AMOUNT: $ 221,030. 2019 AMOUNT: $ 206,906. 2020 AMOUNT: $ 83,303. 2021 AMOUNT: $ 114,342. MEALS - 2017 AMOUNT: $ 406,252. 2018 AMOUNT: $ 444,166. 2019 AMOUNT: $ 515,748. 2020 AMOUNT: $ 578,922. 2021 AMOUNT: $ 653,801. MISCELLANEOUS - 2017 AMOUNT: $ 33,923. 2018 AMOUNT: $ 29,441. 2019 AMOUNT: $ 31,874. 2020 AMOUNT: $ 13,273. 2021 AMOUNT: $ 51,833. ENTRANCE FEES - 2017 AMOUNT: $ 15,000. INSTALLMENT REVENUE - 2017 AMOUNT: $ 5,000. INSURANCE CLAIMS - 2018 AMOUNT: $ 73,838. 2019 AMOUNT: $ 19,672. 2020 AMOUNT: $ 7,520. 2021 AMOUNT: $ 30,979. PET CARE - 2019 AMOUNT: $ 25,721. 2020 AMOUNT: $ 17,564. 2021 AMOUNT: $ 11,336. TRANSPORTATION ASSISTANCE - 2019 AMOUNT: $ 12,865. SPECIAL EVENT INCOME - 2019 AMOUNT: $ 2,304. TEC BAR - 2020 AMOUNT: $ 701. 2021 AMOUNT: $ 430. REBATES - 2020 AMOUNT: $ 14,400. 2021 AMOUNT: $ 31,171. ONBOARDING PAYMENT - 2020 AMOUNT: $ 6,500. DRY CLEANING - 2021 AMOUNT: $ 159. MAINTENANCE SERVICES - 2021 AMOUNT: $ 57,742. QUALITY ENHANCEMENT - 2021 AMOUNT: $ 47,427. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1211 1211 0 PART II-B, LINE 1: MENNO-HAVEN INC PAYS DUES TO LEADINGAGE AND LEADINGAGE PA WHICH ADVOCATE FOR NURSING HOMES AND OTHER CARE FACILITIES FOR THE AGED. SMALL PORTIONS OF THE DUES TO LEADINGAGE AND LEADINGAGE PA ARE USED FOR LOBBYING EXPENSES. 0 1 X 6459053 120731 2509863 663141 8426506 6979829 254382 560646 1335804 6459053 5462182 2421467 229732 1133552 6979829 6906365 155965 -320875 1279273 5462182 6760278 127061 767664 748638 6906365 0.00000 0.39000 0.61000 1 0 3687320 3687320 160429135 58102667 102326468 57247209 28311073 28936136 4609322 4609322 139559246 GIFT ANNUITIES 137000 RESIDENT AND EMPLOYEE FUNDS 808079 REFUNDABLE ENTRANCE FEES 7633704 8578783 63531822 2555281 10800 -90299 2475782 61056040 -452016 -452016 60604024 59457116 10800 452016 462816 58994300 259165 259165 59253465 PART IV, LINE 2B: THE ORGANIZATION IS THE REP PAYEE FOR TWO RESIDENTS WHO RECEIVE THEIR SOCIAL SECURITY FUNDS INTO THE ACCOUNT. THE ORGANIZATION ALSO HOLDS SMALL GUEST FUNDS, WHERE FAMILIES CAN PUT SMALL ALLOWANCES IN TO BE HELD FOR FUTURE USE ONCE THE RESIDENT NEEDS MORE RESTRICTIVE LEVELS OF CARE. THE RESIDENTS THEN WITHDRAW THE FUNDS AS NEEDED. THERE ARE ALSO ESCROW ACCOUNT LIABILITIES THAT ARE DEPOSITS WHICH ARE RECEIVED ON INDEPENDENT LIVING CONTRACTS FOR RESIDENTS WHO HAVE NOT YET MOVED IN. PART V, LINE 4: ENDOWMENT FUNDS ARE MAINTAINED FOR THE BENEFIT OF OUR RESIDENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF BENEFICIAL INTERESTS IN ANNUITIES -2,152. CHANGE IN VALUE OF PERPETUAL TRUSTS 171,018. INVESTMENT MANAGEMENT FEES -259,165. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS -346,470. RENTAL EXPENSES -105,546. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS 346,470. RENTAL EXPENSES 105,546. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES 259,165. X X X 0 0 0 0 0 0 0 0 0 HUGH DAVIS CEO 323926 0 20000 0 12190 0 33168 0 18075 0 407359 0 0 0 DAVID GENTRY CFO (UNTIL JUNE 2022) 215055 0 0 0 690 0 9301 0 14439 0 239485 0 0 0 ROGER BEINS COO 182077 0 25 0 690 0 7918 0 10858 0 201568 0 0 0 CHARLES NELSON CHIEF DEVELOPMENT OFFICER 180035 0 725 0 690 0 18053 0 245 0 199748 0 0 0 LARRY LUGARO DIRECTOR FACILITIES DEVELOPMENT 158569 0 337 0 690 0 8255 0 17522 0 185373 0 0 0 LAURA MINTEER EXEC. DIRECTOR TEAM SVCS. 174439 0 0 0 660 0 0 0 5771 0 180870 0 0 0 TIFFANY RIFE COMMUNITY LIFE OFFICER 151062 0 500 0 690 0 7968 0 8448 0 168668 0 0 0 ROSALYN BURKE ADMINISTRATOR 132360 0 250 0 690 0 7002 0 18562 0 158864 0 0 0 A FRANKLIN COUNTY INDUSTRIAL DEVELOPMENT 232261213 353273B27 2018-09-01 102460808 REFUND PRIOR YEAR BONDS, CONSTRUCTION, FURNISHING & EQUIPMENT 0 0 0 B FRANKLIN COUNTY INDUSTRIAL DEVELOPMENT 232261213 353273CF0 2019-09-04 27462488 CONSTRUCTION, FURNISHING & EQUIPMENT 0 0 0 A 2360000 102460808 6246963 2830342 1644160 47880586 43427500 577905 2020 1 0 1 1 B 27462488 1981567 1516929 536742 22644375 2006909 2021 0 0 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 SUZANNE TRINH BOARD MEMBER OF MENNO-HAVEN AND 100% OWNER OF ZULLINGER-DAVIS-TRINH, P.C. 224934 ZULLINGER-DAVIS-TRINH,P.C. WAS USED IN A REAL ESTATE TRANSACTION. ALL TRANSACTIONS ARE AT ARM'S LENGTH. 0 X 2 35250 APPRAISAL X 5 1427892 NYSE X COINS 2 50583 APPRAISAL 3 0 1 0 PART I, LINE 32B: THE NUMBER OF CONTRIBUTORS IS REPORTED FOR ALL GIFTS. FORM 990, PART VI, SECTION B, LINE 11B INTERNAL FINANCE PERSONNEL PERFORM AN INITIAL REVIEW OF THE FORM 990. ONCE THE DRAFT IS SHARED WITH THE CEO, THE FORM IS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW. DURING A FINANCE COMMITTEE MEETING, MANAGEMENT RESPONDS TO ANY QUESTIONS FROM THE COMMITTEE. THE 990 DRAFT IS THEN MADE AVAILABLE TO THE FULL BOARD AS AN AGENDA ITEM DURING A FULL BOARD MEETING. NOTE THE BOARD REVIEWS THE FORM 990 RATHER THAN "APPROVES" IT AS THE FILING OF THE FORM 990 IS CONSIDERED A MANAGEMENT RESPONSIBILITY. THE FORM 990 IS THEN FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND CORPORATE OFFICERS ARE AMONG THOSE WHO SIGN AN ANNUAL CONFLICT OF INTEREST FORM. THE FORMS ARE REVIEWED BY THE SECRETARY OF THE BOARD AND ANY DISCLOSED CONFLICTS ARE DISCUSSED WITH THE EXECUTIVE COMMITTEE OR APPROPRIATE OFFICERS OF THE GOVERNING BODY. FAMILY AND BUSINESS RELATIONSHIPS ARE EXPRESSLY MENTIONED IN THE CONFLICT OF INTEREST POLICY AS SOURCES OF POTENTIAL CONFLICTS. IF A CONFLICT IS DISCLOSED, THE INTERESTED PARTY MAY NOT PARTICIPATE IN CONSIDERATION OR DISCUSSION OF THE PROPOSED TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO, EXECUTIVE DIRECTOR, AND TOP MANAGEMENT OFFICIALS IS DETERMINED BY A COMPENSATION SURVEY OR STUDY USING PRIMARILY THE LEADING AGE AGENCY WAGE SURVEY OF SIMILAR SIZE FACILITIES. LEADING AGE IS AN ASSOCIATION OF NONPROFIT SENIOR SERVICES IN THE STATE OF PENNSYLVANIA. THE EXECUTIVE COMMITTEE OF THE BOARD ALSO HAS THE LIBERTY TO UTILIZE OTHER SURVEYS OF SIMILAR OPERATIONS IF THEY CHOOSE TO DO SO. COMPENSATION RANGES FOR OTHER OFFICERS AND KEY EMPLOYEES ARE DETERMINED BY A COMPENSATION SURVEY USING THE LEADING AGE PARENT AGENCY WAGE SURVEY. DISCRETION AS TO WHERE THESE EMPLOYEES FALL IN THE APPROPRIATE RANGE IS DETERMINED BY THE EMPLOYEE'S EXPERIENCE AND KNOWLEDGE AND IS DETERMINED BY EACH EMPLOYEE'S SENIOR MANAGER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT ITS ADMINISTRATIVE OFFICES LOCATED AT 2011 SCOTLAND AVE, CHAMBERSBURG, PA 17201. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF BENEFICIAL INTERESTS IN ANNUITIES -2,152. CHANGE IN VALUE OF PERPETUAL TRUSTS 171,018.